If you’ve tried to schedule a physical exam with your doctor recently (or worse, tried to establish care with a new doctor) you probably had to wait a while for an appointment. Sometimes months.
If you called your doctor’s office because you had a sinus infection or the flu, chances are you were told that your doctor’s schedule was already full. If you were lucky, you were offered an appointment with another provider in the office but probably you were directed to your nearest urgent care.
That there is a shortage of general practitioners in this country is unlikely surprising. You have experienced it. And, its only going to get worse.
Many more US medical school graduates become specialists than foreign-born doctors in part because specialists are paid up to 45% more than general practitioners. This doesn’t mean that doctors who choose to specialize are greedy. Studying medicine is an expensive investment (except in countries where education is free).
And the cost is not just financial. Becoming a doctor is a lifelong learning commitment to a demanding job in a hostile healthcare system. For some, the costs simply outweigh the benefits. The result is not enough native-born doctors to meet the growing demand for primary care. This gap in care is partially plugged by foreign-born doctors.
Immigrants make up more than 1/4 of US physicians. They are a major part of the solution to the primary care shortage problem.
After the travel ban was instituted, American Academy of Family Physicians president John Meigs, MD wrote a passionate letter to the president. I was proud to be a member of the AAFP as I read his words. We are writing to express the importance of this nation continuing its historical tradition of welcoming immigration and the talent and energy these individuals bring to this country. The AAFP promotes and advances the work of family physicians from all religions, races, ethnicities and cultures in the United States and around the world.
Dr. Meigs’ words echoed the sentiments of many family physicians. As an organization, we are adamantly opposed to discrimination of all types, including policies that identify or isolate individuals based on their gender, religion, ethnicity, nationality or geographic location.
The conclusion of his letter could have been written about any profession. Fully engaging all talent and expertise in the healthcare community leads to better health outcomes, diversity in medicine and should be encouraged.
Diversity in medicine should be encouraged. In truth, diversity in everything should be encouraged. Immigrants like Albert Einstein (who came to America during the Nazi occupation) and former Secretary of State Madeleine Albright (who immigrated from Czechoslovakia to flee a Communist takeover) bring diversity that makes this country competitive, colorful and vibrant. Americans love Thai food and Chinese New Year celebrations. We like to grocery shop in Little Italy and buy Guatemalan handbags and Mexican glassware. We love diversity.
Immigrants also bring beauty to our country. John Muir, world-famous naturalist and the “Father of Our National Park System,” was an immigrant from Scotland.
That’s correct. An immigrant is largely responsible for the preservation of the beautiful spaces America treasures.
Unless you are a native American, your family immigrated here. Just ask any elementary student. I remember when I was a little girl that I was so proud to live in the country that took in the tired, the hungry and the poor. I believed in the magic of the melting pot.
And, if I hadn’t met and fallen in love with an immigrant, I might not have ever become a doctor.
I didn’t win a coveted spot in an American medical school when I finished college. Competition was fierce. My mentors encouraged me to try again next year. But I had no interest in finding a job in the allied health field to gain experience and make connections like many aspiring medical students. I had bigger plans for my life. I didn’t just want to be a doctor, I wanted to be a mother. I felt a sense of urgency in my career choice. It was now or never.
So, when I was accepted by a prestigious medical school in my future husband Paul’s homeland, we decided to go for it. It was one of the best decisions we ever made.
Almost 2 dozen years later, just after the travel ban was announced, Paul posted a photograph of his family on the anniversary of their immigration. He wrote: Thank you for taking us in America. I am forever faithful and grateful. One of the first comments on this post read “At least you did it legally.”
I was furious. How do you know? I wanted to write. Perhaps it was based on the known merits of his high-achieving family. Perhaps the assumption was made because of the color of Paul’s skin. The truth is never quite so black or white, though.
Paul’s family came to America when life was becoming increasingly difficult in Communist Poland. There were strikes and long lines for food. There was a constant threat of violence and rumors that it would only get worse.
Paul’s father Piotr dreamed of a better life for his family. His mother Irena struggled with the decision. She didn’t want to leave her big Polish family and worried she might not see them again if she did. She had a sister, though, who already lived in America and offered to help. When Irena’s mother encouraged her to join her homesick sister she finally felt free to go.
A lot of pieces had to fall into place before they could make such a dream happen. First, they had to get passports out of the country, which was not easy. Many people they knew had been repeatedly refused. Piotr believes that they were able to get their passports because of family connections to The Party, issued strictly on the condition that they would return. They had to pretend to be just visiting America.
Next, they had to borrow money from impoverished family members to purchase the small apartment that they were leaving behind. Paul’s family of four shared this apartment with Piotr’s mother. There were 2 small rooms, one for the children and one for the grandmother. Paul’s parents slept on the couch. Piotr worried that his mother would be forced out of the apartment if they didn’t return.
Finally, Irena’s sister had to buy all 4 plane tickets in cash with American dollars. It was the only way to secure a spot on the chartered plane. The tickets were round trip, though they had no intention of returning.
Only 3 people knew of their intention to immigrate – Paul’s parents and Irena’s sister in America. Paul didn’t even know that they were going “to visit” America until the night before they left. It was too risky to tell the children ahead of time, too easy to destroy the carefully laid plans. Paul raced to the playground to tell his friends that he was leaving for America tomorrow. No one believed him.
I can’t imagine how his parents felt, full of hope and fear, when they boarded the plane with just a few treasured belongings. They must have been overjoyed to be given a shot at the American dream.
Paul’s family moved in with Irena’s sister and her family of 5. Eventually, they applied for political asylum. Eight year old Przemyslaw (renamed Paul) started school unable to speak a word of English. (Now he corrects mine.)
If Paul’s family had waited much longer, they wouldn’t have been able to leave. Not long after their arrival in America, martial law was put in effect by the communist government. Military vehicles surged onto the streets and the borders were sealed. Phones were disconnected (and later tapped). Mail was censored. School was suspended while teachers were questioned about their loyalty. Those found to be sympathetic to the resistance were fired. Media, transportation, healthcare, public services and factories were put under military management. Military courts bypassed the normal court system to imprison the opposition.
If I lived with my children in an oppressive, potentially violent society with no guarantee of our next meal, I expect that I would do whatever it took to get my children to safety.
What parent wouldn’t?
Countless parents fled such regimes to the safety of our country, many without the connections and luck that Paul’s family had. These parents now live in fear that the children they thought they had saved could be sent back to a homeland that they don’t remember. Children who were brought to America with hopeful parents looking for a better life. Children like Paul and his sister.
Like many Americans, I am outraged by the threatened deportation of DREAMers. These are the children of undocumented immigrants, many with no memories of their “home” country. Some speak only English and had no idea that they were undocumented until they applied for college.
And they weren’t just granted a free ride here. DACA (Deferred Action for Childhood Arrivals) status isn’t cheap and strict criteria must be met, including a willingness to go to college or serve in our military. Those who meet the rigorous requirements and background checks are given a 2 year deferral, a dream, to stay and earn their citizenship.
I know I am lucky to have been born in this county, yet I believe these young Americans, raised among us, are every bit as American as I am.
So does former President Obama. In speaking of the threat of deportation of DREAMers he said:
What makes us American is not a question of what we look like, or where our names come from, or the way we pray. What makes us American is our fidelity to a set of ideals – that all of us are created equal; that all of us deserve the chance to make of our lives what we will; that all of us share an obligation to stand up, speak out, and secure our most cherished values for the next generation. That’s how America has traveled this far. That’s how, if we keep at it, we will ultimately reach that more perfect union.
Universities agreed, citing DACA beneficiaries as outstanding students whose presence enriched the learning environment for all students. Dozens of CEOs (including Apple, Microsoft, Amazon, Netflix, AT&T, Wells Fargo, Facebook, and Google) also joined the protest. As it turns out, 3/4 of the top 25 Fortune 500 companies have employees who are DACA recipients.
Why are we so eager to deport these young people? Children (and grandchildren) of immigrants were likely raised with stories of deprivation. Like Paul, they were taught to appreciate their chance at the American dream and the importance of living up to the privilege of living here. Jonas Edward Salk, who developed the polio vaccine, was the grandchild of Eastern European and Russian immigrants. Henry Judah Heimlich (of the Heimlich maneuver) was the grandchild of Hungarian and Russian Jewish immigrants. Sanjay Gupta, American neurosurgeon and media reporter, is the child of Indian immigrants. Imagine if we had never let these families in (or kicked their children out)?
And yet the future is still uncertain for these young undocumented people.
Meanwhile, our country is becoming increasingly hostile. American citizens are harassed as rumors circulate about people rounded up at their work and homes. My friend’s American family carries identification because, despite being citizens, their ethnic appearance has caused them to be questioned. Their children are directed to come straight home after school. People are scared.
This summer my husband and I decided to go to Canada for our annual birthday bike trip. We were driving in New York along the St. Lawrence river when we came to a roadblock.
A heavily armed man in army fatigues stepped up to our truck. Another armed man, pulled by a lunging German Shepherd, walked around the back and peered into our truck bed. Although we had nothing to hide or fear (we were American citizens in America, after all), I felt my heart quicken.
“What is your relationship?” the man who approached our vehicle asked with a smile.
“We’re married,” Paul and I answered in unison.
“Are you American citizens?” he asked.
“Yes,” we both answered together.
He looked through the window into the back seat of the truck which was piled high with our biking gear.
“Born and raised?” he asked.
“Yes,” I answered quickly.
“No,” said Paul.
I swallowed hard. Did it matter? A year ago I wouldn’t have thought so. But a year ago we probably wouldn’t have been asked.
“Are you naturalized?” he asked Paul. Paul nodded.
“Where and what year?” he asked, his smile fading.
“Hartford, Connecticut,” Paul answered. He stumbled on the year.
I held my breath and then blurted, “1977, right?” When Paul didn’t answer right away I continued, “You were eight, I think. What year was that?”
The pause was infinite.
Eventually, border patrol let us go. We were American citizens, after all.
As we drove away, though, I couldn’t help feeling uneasy about the whole exchange. Shouldn’t the interrogation have ended when we confirmed that we were American citizens? Since when did it matter if a person was “born and raised” here? And, what if we were not white? Might we have been detained longer? Asked to show proof? Had our vehicle searched?
We can’t be lulled into passivity. Even if you are not married to an immigrant, even if your doctor is not a foreigner or foreign-trained, even if you don’t think you even know any immigrants because you live in a homogenous, non-diverse community – make no mistake. You will be impacted by anti-anything-that isn’t-American legislation.
Hopefully the impact will just be a nuisance, like difficulty traveling to another country (or even in your own if you aren’t white or have an accent). Maybe you’ll have to pay more for domestic fruits when there aren’t enough workers to pick it. Maybe you will have to wait a year to schedule a doctor’s appointment. It could be much, much worse though.
When we push away other cultures and and turn our backs on our neighbors we are not just hurting them, we are hurting ourselves. We are creating a deep wound in our society when we speak of building a wall or deporting young adults. When we allow the pardon of a sheriff renowned for racial profiling and violence we are sending a message to Americans (and to the rest of the world) that we accept bigotry and hatred.
When we react to each horrific act of terrorism by blaming an entire population (or dehumanize the perpetrator by labeling him “an animal”) we most definitely are not making America safer. We are furthering a division that, in small and terrifying pockets, may lead to extremism and actually cause terrorism.
I am a primary care doctor in a mostly white, rural community with relatives who arrived on the Mayflower. Yet the impact of anti-immigration and anti-anything-not-American on my own small life can’t be denied. I suspect if you look deep enough, you will discover that the impact on yours can’t be either.
I don’t want to live in a black and white world when I could live in rainbow.